LIVER FIBROSIS AND RISK OF PORTAL VEIN THROMBOSIS IN NON-ALCOHOLIC FATTY LIVER DISEASE

Abstract

Portal vein thrombosis (PVT) is more common in patients with cirrhosis as compared to those without cirrhosis. Complete occlusion of portal vein is associated with high mortality, poor post-transplant survival and these patients are sometimes precluded from liver transplantation.(1),(2),(3) It is not established if the etiology of liver disease also contributes to PVT risk factors. There are discordant reports on risk of PVT in NASH cirrhosis as compared to non-NASH cirrhosis. (4),(5),(6) Additionally, there are limited pharmacologic options for management of NASH cirrhosis. Literature had shown reduced decompensation in cirrhosis patients who used statin.(7) In our first paper we used electronic health record data and studied the association of presumed NASH with incidence of PVT. Moreover, relation of statin use and PVT incidence was also reported. Non-alcoholic steatohepatitis (NASH) is leading cause of chronic liver disease and liver transplantation.(8) Mechanism of progression of steatosis to advanced fibrosis in this population is not understood. Previous observation showed mitochondrial damage and impaired fatty acid oxidation in NASH which may impact citric acid cycle (TCA). (9),(10) Liver fibrosis reflects the advancement of liver disease and relation of citrate levels with liver fibrosis is not known. In our second paper we used biopsy proven NASH registry data to test the relation of serum citrate levels with liver fibrosis. We validated this relation in multicenter biopsy proven NASH population. Furthermore, we tested performance of citrate levels to differentiate the degree of fibrosis.